Pathology Labs Making Progress on Removing Race for Kidney Function Estimates

NEW ORLEANS -- Pathology labs are beginning to incorporate non-race-based estimated glomerular filtration rate (eGFR) reference values into their testing protocols, several speakers said at the College of American Pathology (CAP) conference.

"This is an important change," Bobbi Pritt, MD, MSc, chair of the clinical microbiology division at the Mayo Clinic in Rochester, Minnesota, said at a press briefing. "We are physicians; we're scientists, we need to base our testing and how we report our tests on science."

The briefing included a video featuring La'Tonzia Adams, MD, a pathologist at the VA Portland Health Care System in Oregon; Adams's father, who was African American, died from kidney disease. "The misconception started with the assumption that African Americans have more muscle mass, therefore they make more creatinine," she said.

As a result of the misconception, an adjustment was made specifically for African Americans in the calculation of their eGFR rate, "and this equation gave [providers] a misconception of less severe kidney disease in African Americans," said Adams. "So that makes them ineligible for certain medication regimens [and] transplant lists when they were actually more severe than how they appear ... That will disqualify them from transplants that they rightfully should have had."

In her father's case, "he wasn't given the best attention in regards to his kidney disease," and wasn't referred to a nephrologist until it was too late, Adams said. With the new non-race-based formula, "Maybe my father would have truly benefited from it." Without such changes, "you're taking away the option for someone to get as much care and opportunity for survival."

The change came about following a September 2021 report from a joint task force of the National Kidney Foundation (NKF) and the American Society of Nephrology. The report authors urged laboratories and clinicians to immediately adopt a new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation when screening U.S. adults. "From what I'm seeing, most laboratories have changed over if they haven't, they're in the process," Adams said.

Kalisha Hill, MD, MBA, medical director of pathology and laboratory services at Ascension Saint Mary Kankakee in Illinois, said at the briefing that "this strikes home for me because I have a good friend who was on the transplant list for 5 years. And she finally did receive her kidney transplant and now is very active in the NKF, doing just this education so the community at large understands to look for the proper eGFR testing and making sure that they're not being excluded from their opportunity to be on a transplant list." Hill added that her own laboratory implemented the new equation "as soon as it was available back in the spring, and we've made sure that our patients within our hospital system receive the accurate reference ranges for this test."

Panelists at the briefing also discussed the care of transgender patients as it related to laboratory reference ranges. "This is very personal for me," said CAP president-elect Donald Karcher, MD, immediate past chair of pathology at George Washington University Medical Center in Washington. "I have a close family member who is transgender, and many transgender people are on hormone therapy or receive other gender-affirming treatments. And those treatments can actually change the reference ranges for some laboratory tests ... And of course, that can really significantly impact whether or not a patient gets treatment, and [whether] they get the correct treatment."

"I'm very proud of the CAP -- and frankly, the entire laboratory community -- that is now diligently working to make sure that we're using the correct reference ranges for all people who could be transgender," he added.

Restrictions on blood donations by gay men was another topic of conversation at the briefing. It had been a longstanding policy to defer donations from gay men "going back to the onset of the AIDS pandemic, in which gay men were at risk for HIV infection," said Glenn Ramsey, MD, a pathology professor at Northwestern University Feinberg School of Medicine in Chicago. "More recently, this has changed to a 3-month deferral for men who have sex with men, based on gender."

However, he explained, "the FDA is funding a study to look at this question ... We hope to get to a point where there will not be a gender-based deferral, but a deferral based on risk behavior. Not only would this allow some more dedicated donors to be able to donate, it would also help the blood supply in an important way." CAP is supporting this study, which is ongoing at several blood centers, so "stay tuned for further details on that in the coming months and years," Ramsey said.

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